Psychopharmacology – A brief introduction

Objectives Review general categories of psychiatric disorders Review general categories of psychiatric disorders Review classes of psychotropic medications Review classes of psychotropic medications General principles of treatment General principles of treatment

Psychiatric Disorders Psychotic Disorders Psychotic Disorders Schizophrenia, Schizoaffective Disorder Schizophrenia, Schizoaffective Disorder Mood Disorders Mood Disorders Depression, Bipolar Disorder Depression, Bipolar Disorder Anxiety Disorders Anxiety Disorders Generalized anxiety disorder, panic disorder, PTSD Generalized anxiety disorder, panic disorder, PTSD Alcohol and Substance Use Disorders Alcohol and Substance Use Disorders Personality Disorders Personality Disorders Cluster A (odd); Cluster B (dramatic); Cluster C (anxious) Cluster A (odd); Cluster B (dramatic); Cluster C (anxious) Adjustment Disorders Adjustment Disorders Cognitive Disorders Cognitive Disorders Delirium, Dementia Delirium, Dementia

Classes of Psychotropic Medications Antipsychotics Antipsychotics Conventional Conventional Atypical Atypical Antidepressants Antidepressants SSRIs SSRIs SNRIs SNRIs Tricyclic Antidepressants Tricyclic Antidepressants MAOIs MAOIs Others Others Mood Stabilizers Mood Stabilizers Lithium Lithium Anticonvulsants Anticonvulsants Atypical antipsychotics Atypical antipsychotics

Psychotropic Medications Anxiolytics Anxiolytics Antidepressants Antidepressants Benzodiazepines Benzodiazepines Other agents Other agents Medications for dementias Medications for dementias Cholinesterase inhibitors Cholinesterase inhibitors Memantine Memantine Medications for substance use disorders Medications for substance use disorders Alcohol use disorders Alcohol use disorders Opioid substitution therapies Opioid substitution therapies Nicotine dependence Nicotine dependence Others Others Medications used to treat “side effects” Medications used to treat “side effects” Medications used for augmentation Medications used for augmentation Sleep aids Sleep aids

Considerations in Choosing Medication(s) Diagnosis Diagnosis Target symptoms Target symptoms Severity of symptoms Severity of symptoms Side effects of medications Side effects of medications Drug interactions Drug interactions Compliance Compliance Alternatives/adjuncts to medications (psychotherapy, social treatments) Alternatives/adjuncts to medications (psychotherapy, social treatments)

Psychotic Disorders Antipsychotics are generally first-line Antipsychotics are generally first-line Consider Consider Typical vs. atypical Typical vs. atypical Side effects of the medication Side effects of the medication Compliance (need for long-acting injectable forms) Compliance (need for long-acting injectable forms) Need for adjunctive medications Need for adjunctive medications Antidepressants, sleep aids, side effect medications Antidepressants, sleep aids, side effect medications Treatment resistance (need for clozapine) Treatment resistance (need for clozapine)

Mood Disorders Depression Depression Need to rule out bipolar disorder Need to rule out bipolar disorder SSRIs generally first line SSRIs generally first line TCAs and MAOIs are effective medications – side effects limit use TCAs and MAOIs are effective medications – side effects limit use Bipolar disorder Bipolar disorder Mood stabilizers are first line Mood stabilizers are first line All choices have significant side effects All choices have significant side effects Considerations – “classic mania”, rapid cycling, bipolar depression, comorbid medications and medical conditions Considerations – “classic mania”, rapid cycling, bipolar depression, comorbid medications and medical conditions

Anxiety Disorders SSRIs, other antidepressants are first line choices SSRIs, other antidepressants are first line choices Benzodiazepines – should be used short-term if at all possible Benzodiazepines – should be used short-term if at all possible Many augmentation strategies depending upon diagnosis Many augmentation strategies depending upon diagnosis Don’t forget about psychotherapy! Don’t forget about psychotherapy!

Alcohol and Substance Use Disorders Pharmacology often not considered Pharmacology often not considered Alcohol Alcohol Disulfiram Disulfiram Naltrexone Naltrexone Acamprosate Acamprosate Opioids Opioids Methadone Methadone Buprenorphine Buprenorphine Tobacco Tobacco Nicotine replacement Nicotine replacement Bupropion Bupropion Varenicline Varenicline

Personality Disorders No current pharmacologic approaches of proven efficacy No current pharmacologic approaches of proven efficacy Psychotherapies are first line Psychotherapies are first line Many approaches Many approaches Antidepressants, antipsychotics, lithium, mood stabilizers Antidepressants, antipsychotics, lithium, mood stabilizers Some are helpful Some are helpful

Case discussion Diagnostic thoughts? Diagnostic thoughts? Classes of medications to consider in treatment? Classes of medications to consider in treatment? Discussion of patient’s current treatment Discussion of patient’s current treatment

QUESTIONS?